Effect of personalized dietary advice to increase protein intake on food consumption and the environmental impact of the diet in community-dwelling older adults: results from the PROMISS trial

Alessandra C Grasso, Margreet R Olthof, Ilse Reinders, Hanneke A H Wijnhoven, Marjolein Visser, Ingeborg A Brouwer, Alessandra C Grasso, Margreet R Olthof, Ilse Reinders, Hanneke A H Wijnhoven, Marjolein Visser, Ingeborg A Brouwer

Abstract

Purpose: Diet modelling studies suggest that increasing protein intake with no consideration for sustainability results in a higher environmental impact on the diet. To better understand the impact in real life, the aim of this study was to assess the effect of dietary advice to increase protein intake on food consumption and the environmental impact of the diet in community-dwelling older adults.

Methods: Food consumption and environmental impact were analyzed among 124 Dutch older adults with lower habitual protein intake (< 1.0 g/kg adjusted body weight/day) participating in the six-month PROMISS trial. Dietary intake data from three 24-h dietary recalls, aided by food diaries, and results from life cycle assessments were used to examine the differences in changes in food consumption and environmental impact between those who received dietary advice to isocalorically increase protein intake to ≥ 1.2 g/kg aBW/d (Protein + ; n = 84) and those who did not receive dietary advice (Control; n = 40).

Results: Compared to the Control, Protein + increased protein intake from animal-based food products (11.0 g protein/d, 95% CI 6.6-15.4, p < 0.001), plant-based food products (2.1 g protein/d, 95% CI 0.2-4.0, p = 0.031) and protein-enriched food products provided during the trial (18 g protein/d, 95% CI 14.5-21.6, p < 0.001) at the 6-month follow-up. Diet-associated greenhouse gas emissions increased by 16% (p < 0.001), land use by 19% (p < 0.001), terrestrial acidification by 20% (p = 0.01), and marine eutrophication by 16% (p = 0.035) in Protein + compared to the Control.

Conclusion: This study found that dietary advice increased protein intake, favoring animal-based protein, and increased the environmental impact of the diet in older adults.

Trial registration: ClinicalTrials.gov. NCT03712306. October 2018.

Keywords: Diet; Older adults; Protein; RCT; Sustainability.

Conflict of interest statement

The authors have no conflicts of interest to declare.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Six-month change in protein intake (in g/d) by protein source among those who received dietary advice aiming at increasing protein intake (Protein + group) compared to those who did not receive dietary advice (Control group) during the PROMISS trial (N = 124), adjusted for sex, baseline energy intake and baseline value of outcome. The dots represent the effect size estimates and lines represent 95% confidence intervals. * p 

References

    1. Deer RR, Volpi E. Protein intake and muscle function in older adults. Curr Opin Clin Nutr Metab Care. 2015;18(3):248–253. doi: 10.1097/MCO.0000000000000162.
    1. Volkert D, Kiesswetter E, Cederholm T, Donini LM, Eglseer D, Norman K, et al. Development of a model on determinants of malnutrition in aged persons: A MaNuEL Project. Gerontol Geriatr Med. 2019;5:2333721419858438. doi: 10.1177/2333721419858438.
    1. de Boer A, Ter Horst GJ, Lorist MM. Physiological and psychosocial age-related changes associated with reduced food intake in older persons. Ageing Res Rev. 2013;12(1):316–328. doi: 10.1016/j.arr.2012.08.002.
    1. Buford TW, Anton SD, Judge AR, Marzetti E, Wohlgemuth SE, Carter CS, et al. Models of accelerated sarcopenia: Critical pieces for solving the puzzle of age-related muscle atrophy. Ageing Res Rev. 2010;9(4):369–383. doi: 10.1016/j.arr.2010.04.004.
    1. Kiesswetter E, Sieber CC, Volkert D. Protein intake in older people. Z Gerontol Geriatr. 2020;53(4):285–289. doi: 10.1007/s00391-020-01723-4.
    1. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16–31. doi: 10.1093/ageing/afy169.
    1. Xia L, Zhao R, Wan Q, Wu Y, Zhou Y, Wang Y, et al. Sarcopenia and adverse health-related outcomes: An umbrella review of meta-analyses of observational studies. Cancer Med. 2020;9(21):7964–7978. doi: 10.1002/cam4.3428.
    1. Mendonça N, Kingston A, Granic A, Jagger C. Protein intake and transitions between frailty states and to death in very old adults: the Newcastle 85+ study. Age Ageing. 2019;49(1):32–38. doi: 10.1093/ageing/afz142.
    1. Moore DR, Churchward-Venne TA, Witard O, Breen L, Burd NA, Tipton KD, et al. Protein ingestion to stimulate myofibrillar protein synthesis requires greater relative protein intakes in healthy older versus younger men. J Gerontol A. 2015;70(1):57–62. doi: 10.1093/gerona/glu103.
    1. Katsanos CS, Kobayashi H, Sheffield-Moore M, Aarsland A, Wolfe RR. Aging is associated with diminished accretion of muscle proteins after the ingestion of a small bolus of essential amino acids. Am J Clin Nutr. 2005;82(5):1065–1073. doi: 10.1093/ajcn/82.5.1065.
    1. Isanejad M, Mursu J, Sirola J, Kröger H, Rikkonen T, Tuppurainen M, et al. Dietary protein intake is associated with better physical function and muscle strength among elderly women. Br J Nutr. 2016;115(7):1281–1291. doi: 10.1017/S000711451600012X.
    1. Lemieux FC, Filion ME, Barbat-Artigas S, Karelis AD, Aubertin-Leheudre M. Relationship between different protein intake recommendations with muscle mass and muscle strength. Climacteric. 2014;17(3):294–300. doi: 10.3109/13697137.2013.829440.
    1. Mendonça N, Hengeveld LM, Visser M, Presse N, Canhão H, Simonsick EM, et al. Low protein intake, physical activity, and physical function in European and North American community-dwelling older adults: a pooled analysis of four longitudinal aging cohorts. Am J Clin Nutr. 2021;114(1):29–41. doi: 10.1093/ajcn/nqab051.
    1. Health Council of the Netherlands (2021) Evaluation of dietary reference values for protein. Background document to: Dietary reference values for protein 2021/10. Health Council of the Netherlands, The Hague
    1. Bauer J, Biolo G, Cederholm T, Cesari M, Cruz-Jentoft AJ, Morley JE, et al. Evidence-based recommendations for optimal dietary protein intake in older people: A position paper from the PROT-AGE study group. J Am Med Dir Assoc. 2013;14(8):542–559. doi: 10.1016/j.jamda.2013.05.021.
    1. Deutz NEP, Bauer JM, Barazzoni R, Biolo G, Boirie Y, Bosy-Westphal A, et al. Protein intake and exercise for optimal muscle function with aging: Recommendations from the ESPEN Expert Group. Clin Nutr. 2014;33(6):929–936. doi: 10.1016/j.clnu.2014.04.007.
    1. Richter M, Baerlocher K, Bauer JM, Elmadfa I, Heseker H, Leschik-Bonnet E, et al. Revised reference values for the intake of protein. Ann Nutr Metab. 2019;74(3):242–250. doi: 10.1159/000499374.
    1. Chen C, Chaudhary A, Mathys A. Dietary change scenarios and implications for environmental, nutrition, human health and economic dimensions of food sustainability. Nutrients. 2019;11(4):856. doi: 10.3390/nu11040856.
    1. de Gavelle E, Leroy P, Perrimon M, Huneau J-F, Sirot V, Orset C, et al. Modeled gradual changes in protein intake to increase nutrient adequacy lead to greater sustainability when systematically targeting an increase in the share of plant protein. Clim Change. 2019 doi: 10.1007/s10584-019-02592-6.
    1. Grasso AC, Olthof MR, van Dooren C, Broekema R, Visser M, Brouwer IA. Protein for a healthy future: How to increase protein intake in an environmentally sustainable way in older adults in the Netherlands. J Nutr. 2020;151(1):109–119. doi: 10.1093/jn/nxaa322.
    1. IPCC (2019) Climate Change and Land: An IPCC special report on climate change, desertification, land degradation, sustainable land management, food security, and greenhouse gas fluxes in terrestrial ecosystems. Intergovernmental Panel on Climate Change (IPCC), Geneva, Switzerland
    1. Willett W, Rockstrom J, Loken B, Springmann M, Lang T, Vermeulen S, et al. Food in the Anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems. Lancet. 2019;393(10170):447–492. doi: 10.1016/s0140-6736(18)31788-4.
    1. Notarnicola B, Tassielli G, Renzulli PA, Castellani V, Sala S. Environmental impacts of food consumption in Europe. J Clean Prod. 2017;140:753–765. doi: 10.1016/j.jclepro.2016.06.080.
    1. Garnett T, Godde C, Muller A, Röös E, Smith P, de Boer I et al (2017) Grazed and confused? Ruminanting on cattle, grazing systems, methane, nitrous oxide, the soil carbon sequestration question - and what it all means for greenhouse gas emissions. Food Climate Research Network, Oxford Martin Programme on the Future of Food, Environmental Change Institute, University of Oxford, Oxford
    1. Ocké M, Buurma-Rethans E, Bd EJ, W-vdH C, Z E-G, JJMM D, , et al. Diet of community-dwelling older adults: Dutch National Food Consumption Survey Older Adults 2010–2012. Bilthoven, The Netherlands: National Institute for Public Health and the Environment; 2013.
    1. Ocké MC, Toxopeus IB, Geurts M, Mengelers MJB, Temme EHM, Hoeymans N (2017) What is on our plate? Safe, healthy and sustainable diets in the Netherlands. RIVM Report 2017–0024. Rijksinstituut voor Volksgezondheid en Milieu, Bilthoven
    1. Reinders I, Wijnhoven HAH, Jyväkorpi SK, Suominen MH, Niskanen R, Bosmans JE, et al. Effectiveness and cost-effectiveness of personalised dietary advice aiming at increasing protein intake on physical functioning in community-dwelling older adults with lower habitual protein intake: rationale and design of the PROMISS randomised controlled trial. BMJ Open. 2020;10(11):e040637. doi: 10.1136/bmjopen-2020-040637.
    1. Reinders I, Visser M, Jyväkorpi SK, Niskanen RT, Bosmans JE, Jornada Ben Â, et al. The cost effectiveness of personalized dietary advice to increase protein intake in older adults with lower habitual protein intake: a randomized controlled trial. Eur J Nutr. 2021 doi: 10.1007/s00394-021-02675-0.
    1. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–198. doi: 10.1016/0022-3956(75)90026-6.
    1. Hengeveld LM, Boer JMA, Gaudreau P, Heymans MW, Jagger C, Mendonça N, et al. Prevalence of protein intake below recommended in community-dwelling older adults: a meta-analysis across cohorts from the PROMISS consortium. J Cachexia Sarcopenia Muscle. 2020 doi: 10.1002/jcsm.12580.
    1. Paddon-Jones D, Rasmussen BB. Dietary protein recommendations and the prevention of sarcopenia. Curr Opin Clin Nutr Metab Care. 2009;12(1):86–90. doi: 10.1097/MCO.0b013e32831cef8b.
    1. Deutz NE, Wolfe RR. Is there a maximal anabolic response to protein intake with a meal? Clin Nutr. 2013;32(2):309–313. doi: 10.1016/j.clnu.2012.11.018.
    1. The Netherlands Nutrition Center (Voedingscentrum) Eetmeter. .
    1. National Institute for Public Health and the Environment (RIVM) (2016) Nederlands Voedingsstoffenbestand 2016 (Dutch Food Composition Table 2016).
    1. Slimani N, Ferrari P, Ocké M, Welch A, Boeing H, van Liere M, et al. Standardization of the 24-hour diet recall calibration method used in the European Prospective Investigation into Cancer and Nutrition (EPIC): general concepts and preliminary results. Eur J Clin Nutr. 2000;54(12):900–917. doi: 10.1038/sj.ejcn.1601107.
    1. Commission. E (2014) Regulation (EC) No 1924/2006 of the European Parliament and of the Council of 20 December 2006 on nutrition and health claims made on foods. .
    1. Database environmental impact of foods (2021) .
    1. Vellinga RE, van de Kamp M, Toxopeus IB, van Rossum CTM, de Valk E, Biesbroek S, et al. Greenhouse gas emissions and blue water use of Dutch diets and its association with health. Sustainability. 2019;11(21):6027. doi: 10.3390/su11216027.
    1. Twisk J. Applied Longitudinal Data Analysis for Epidemiology: A Practical Guide. Second Edition edn: Cambridge University Press, Cambridge, UK; 2013.
    1. Twisk J, Bosman L, Hoekstra T, Rijnhart J, Welten M, Heymans M. Different ways to estimate treatment effects in randomised controlled trials. Contemp Clin Trials Commun. 2018;10:80–85. doi: 10.1016/j.conctc.2018.03.008.
    1. Banovic M, Arvola A, Pennanen K, Duta DE, Brückner-Gühmann M, Lähteenmäki L, et al. Foods with increased protein content: A qualitative study on European consumer preferences and perceptions. Appetite. 2018;125:233–243. doi: 10.1016/j.appet.2018.01.034.
    1. van der Zanden LDT, van Kleef E, de Wijk RA, van Trijp HCM. Knowledge, perceptions and preferences of elderly regarding protein-enriched functional food. Appetite. 2014;80:16–22. doi: 10.1016/j.appet.2014.04.025.
    1. Beelen J, de Roos NM, de Groot LCPGM. A 12-week intervention with protein-enriched foods and drinks improved protein intake but not physical performance of older patients during the first 6 months after hospital release: a randomised controlled trial. Br J Nutr. 2017;117(11):1541–1549. doi: 10.1017/S0007114517001477.
    1. Ziylan C, Haveman-Nies A, Kremer S, de Groot LCPGM. Protein-enriched bread and readymade meals increase community-dwelling older adults' protein intake in a double-blind randomized controlled trial. J Am Med Dir Assoc. 2017;18(2):145–151. doi: 10.1016/j.jamda.2016.08.018.
    1. Beelen J, de Roos NM, de Groot LCPGM (2017) Protein enrichment of familiar foods as an innovative strategy to increase protein intake in institutionalized elderly. J Nutr Health Aging 21 (2):173–179. https://doi.rog/10.1007/s12603-016-0733-y
    1. Braun M, Muñoz I, Schmidt JH, Thrane M (2016) Sustainability of soy protein from life cycle assessment. FASEB J 30 (S1):894.895–894.895. 10.1096/fasebj.30.1_supplement.894.5
    1. Papademas P, Kotsaki P (2019) Technological utilization of whey towards sustainable exploitation. Adv Dairy Res 7:1–10. 10.35248/2329-888X.7.4.231
    1. Bacenetti J, Bava L, Schievano A, Zucali M. Whey protein concentrate (WPC) production: Environmental impact assessment. J Food Eng. 2018;224:139–147. doi: 10.1016/j.jfoodeng.2017.12.018.
    1. Lonnie M, Johnstone AM. The public health rationale for promoting plant protein as an important part of a sustainable and healthy diet. Nutr Bull. 2020;45(3):281–293. doi: 10.1111/nbu.12453.
    1. Kromhout D, Spaaij CJK, de Goede J, Weggemans RM. The 2015 Dutch food-based dietary guidelines. Eur J Clin Nutr. 2016;70(8):869–878. doi: 10.1038/ejcn.2016.52.
    1. The Netherlands Nutrition Center (Voedingscentrum) (2018) Source document: Towards a more plant-based diet (in Dutch). Voedingscentrum, The Hague
    1. Lim MT, Pan BJ, Toh DWK, Sutanto CN, Kim JE. Animal protein versus plant protein in supporting lean mass and muscle strength: A systematic review and meta-analysis of randomized controlled trials. Nutrients. 2021;13(2):661. doi: 10.3390/nu13020661.
    1. Berrazaga I, Micard V, Gueugneau M, Walrand S. The role of the anabolic properties of plant- versus animal-based protein sources in supporting muscle mass maintenance: A critical review. Nutrients. 2019;11(8):1825. doi: 10.3390/nu11081825.
    1. van der Pols-Vijlbrief R, Wijnhoven HA, Schaap LA, Terwee CB, Visser M. Determinants of protein-energy malnutrition in community-dwelling older adults: a systematic review of observational studies. Ageing Res Rev. 2014;18:112–131. doi: 10.1016/j.arr.2014.09.001.
    1. Reinders I, Visser M, Jyväkorpi SK, Niskanen RT, Bosmans JE, Ben ÂJ et al (in press) The (cost-)effectiveness of personalized dietary advice to increase protein intake on change in physical functioning in older adults with lower habitual protein intake: A randomized controlled trial. Eur J Nutr
    1. Masset G, Vieux F, Verger EO, Soler L-G, Touazi D, Darmon N. Reducing energy intake and energy density for a sustainable diet: a study based on self-selected diets in French adults. Am J Clin Nutr. 2014;99(6):1460–1469. doi: 10.3945/ajcn.113.077958.
    1. Mertens E, Kuijsten A, van Zanten HHE, Kaptijn G, Dofková M, Mistura L, et al. Dietary choices and environmental impact in four European countries. J Clean Prod. 2019;237:117827. doi: 10.1016/j.jclepro.2019.117827.
    1. Broekema R, Tyszler M, van 't Veer P, Kok FJ, Martin A, Lluch A et al (2020) Future-proof and sustainable healthy diets based on current eating patterns in the Netherlands. Am J Clin Nutr 112 (5):1338–1347. 10.1093/ajcn/nqaa217
    1. Celis-Morales C, Lara J, Mathers JC. Personalising nutritional guidance for more effective behaviour change. Proc Nutr Soc. 2015;74(2):130–138. doi: 10.1017/S0029665114001633.
    1. Freedman LS, Guenther PM, Dodd KW, Krebs-Smith SM, Midthune D. The population distribution of ratios of usual intakes of dietary components that are consumed every day can be estimated from repeated 24-hour recalls. J Nutr. 2009;140(1):111–116. doi: 10.3945/jn.109.110254.
    1. Shim J-S, Oh K, Kim HC. Dietary assessment methods in epidemiologic studies. Epidemiol Health. 2014;36:e2014009–e2014009. doi: 10.4178/epih/e2014009.
    1. Naska A, Lagiou A, Lagiou P (2017) Dietary assessment methods in epidemiological research: current state of the art and future prospects. F1000Research 6:926–926. 10.12688/f1000research.10703.1
    1. Natarajan L, Pu M, Fan J, Levine RA, Patterson RE, Thomson CA, et al. Measurement error of dietary self-report in intervention trials. Am J Epidemiol. 2010;172(7):819–827. doi: 10.1093/aje/kwq216.
    1. Willett WC (1998) Issues in analysis and presentation of dietary data. In: WC W (ed) Nutritional Epidemiology. 2nd edn. Oxford University Press, New York, USA, pp 321–346
    1. Reap J, Roman F, Duncan S, Bras B. A survey of unresolved problems in life cycle assessment. Int J LCA. 2008;13(5):374. doi: 10.1007/s11367-008-0009-9.
    1. Rose D, Heller MC, Roberto CA. Position of the Society for Nutrition Education and Behavior: The importance of including environmental sustainability in dietary guidance. J Nutr Educ Behav. 2019;51(1):3–15.e11. doi: 10.1016/j.jneb.2018.07.006.
    1. Poore J, Nemecek T. Reducing food’s environmental impacts through producers and consumers. Science. 2018;360(6392):987–992. doi: 10.1126/science.aaq0216.
    1. Sabaté J, Sranacharoenpong K, Harwatt H, Wien M, Soret S. The environmental cost of protein food choices. Public Health Nutr. 2014;18(11):2067–2073. doi: 10.1017/S1368980014002377.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir